AccountId: 011433970860
ContactId: 5693e7c8-4c78-4b28-9f27-ad3c0879b2cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520020 ms
Total Talk Time (AGENT): 325977 ms
Total Talk Time (CUSTOMER): 256010 ms
Interruptions: 20
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/5693e7c8-4c78-4b28-9f27-ad3c0879b2cb_20250328T12:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, [PII], my name is [PII] and I have, um, a, uh, APL through my work and I have two claims that I need to process. How would I do that?
[AGENT][NEUTRAL] OK, so you're the insured and you're gonna be filing your own claims, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that's the way it works, right? Or can I have the doctor do it next time?
[AGENT][POSITIVE] Uh, yes, ma'am. I can help you with all of that and explain, um, all of this to you because I'm so sorry if you could please give me your first name again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My first name is [PII]
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], what is your last name?
[CUSTOMER][NEUTRAL] OK, it's two last names. It's [PII], which is [PII]
[AGENT][POSITIVE] Thank you and your call back number please [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And your policy number now, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the 16701 transferred out, you know, whatever, you know, from his account balance.
[AGENT][NEUTRAL] OK. Now, that's gonna be your group number. On your ID card, depending on the type of policy you have Yvette, as to how it would be worded, you may see an in-hospital or outpatient.
[CUSTOMER][NEUTRAL] minus uh 17 2 2525.
[AGENT][NEUTRAL] Certificate number.
[CUSTOMER][NEUTRAL] OK, there we go.
[CUSTOMER][NEUTRAL] OK, I'll give you the outpatient 02593393 ML 8.
[AGENT][NEUTRAL] OK, thank you, so give me a moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] 10, 17,275.
[CUSTOMER][NEUTRAL] Uh, no, it's a lot of [PII].
[CUSTOMER][NEUTRAL] Street.
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] But that's not.
[AGENT][NEUTRAL] OK, and so if you have any information that I do provide for you would be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's been a lot.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] address.
[CUSTOMER][NEUTRAL] Orders.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. [PII]. That's the number that's my cell number. There should be only one number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is different than the one you gave me. What is another number that we may have for you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry, did, what was the very last digit of that phone number?
[CUSTOMER][NEUTRAL] Yeah, I don't
[CUSTOMER][NEUTRAL] [PII] is the last four digits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And then the last thing to verify is your email address. This does appear to be your work email.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, thank you so much. Now, on your address, I'm sorry, on your phone number, [PII], double check with your HR department. We've received your phone number ending in [PII] of [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] The account number oh.
[CUSTOMER][NEUTRAL] I don't know what that number could be.
[AGENT][NEUTRAL] But I have, yeah, I don't, I don't know either, but I just, you know, you would need to make sure that they have it correct in the system so that it doesn't get overridden and changed back to the 50 that we have. OK? So give me just a moment.
[CUSTOMER][NEUTRAL] We'd yeah.
[CUSTOMER][NEUTRAL] Yeah, I just
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Ending in 88.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] Good morning guys.
[AGENT][NEUTRAL] OK, so you will be, so you are going to file your own claim at this point, is that correct? OK, so have you set up.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes. Oh yeah, I, yeah, mhm.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] You can do that and I can email you the user guide for our portal here at APL called the online service center and when you set up your profile [PII] that's gonna give you access to your ID cards, policy information, and the ability to submit claims to us for review. I can also include.
[CUSTOMER][NEUTRAL] So nobody gets in there
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] On Sunday Monday and then.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] And I.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The Medin claim form in addition to that user guide and the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First page at the top on the claim form does give you the instructions of the additional documentation that you will need to provide along with the claim for review.
[AGENT][NEUTRAL] Now, in the future, I would recommend, you know, just presenting your APL ID card along with your primary insurance card to your providers when you go for medical services because most providers will file both insurances for you.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Which saves you just, you know, a little extra of having to.
[AGENT][NEUTRAL] Acquire the required documentation.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Um, so the email that I'm gonna send to you just as soon as we get off the phone will come from care team at [PII] and I will put APL in the subject line so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have any other questions or is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well, OK, so how is it that it works? What is it exactly that it covers like for instance, if I'm seeing an endocrinologist that's out of network and I'm paying out of pocket.
[CUSTOMER][NEUTRAL] Um, is, is that, uh, it, I'm sorry.
[AGENT][NEUTRAL] OK, now.
[AGENT][NEUTRAL] No, go ahead with your question.
[CUSTOMER][NEUTRAL] Is that is, yeah, how, how would I, I mean I would process that because I'm paying it out of pocket how much of that is covered?
[AGENT][NEUTRAL] OK, so for, OK, so office visits under this supplemental policy are not covered.
[CUSTOMER][NEUTRAL] Just as an example.
[AGENT][NEUTRAL] If you were to, if you were to receive some type of treatment rendered in the doctor's office, then the treatment itself, that could be reviewed under your outpatient benefit, which you have a $1500 calendar year maximum benefit for covered outpatient services.
[CUSTOMER][NEGATIVE] Oh, they're not OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A.
[AGENT][NEUTRAL] And then if you were to have, you know, like.
[CUSTOMER][NEUTRAL] it doesn't apply, yeah.
[AGENT][NEUTRAL] X-rays or scans or outpatient surgery. Those types of things are things that can be reviewed. If you were to have lab work that was sent to an independent lab company, that is also something that would, you know, fall under your outpatient benefit, max.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, it's fine. Yeah, it works.
[AGENT][NEUTRAL] And if you were to be admitted as an inpatient into a hospital, that calendar, your maximum benefit is 1500. Now, I will let you know if anything, you know, is not covered by your primary insurance, it would also not be covered by APL.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And does this also include like dental work that need would under the coverage or no?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am. This is a supplemental medical policy. Correct. Yes, ma'am. Uh-huh. And again, once you set up that profile in your portal, you will have access to a copy of your policy certificate that has all of your benefit information in it, you know, as well that you can pull up for just viewing or download it, yeah.
[CUSTOMER][POSITIVE] And so this is just medical. OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect all right thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] OK, well then thank you again for calling APO and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.